(By Delegates Hatfield, Susman, Collins and Marshall)[Introduced February 25, 1999; referred to theCommittee on Government Organization then Finance.]

A BILL to amend chapter thirty-three of the code of West
Virginia, one thousand nine hundred thirty-one, as amended,
by adding thereto a new article, designated article
twenty-five-d, relating to establishing a managed care
policy board to oversee and monitor the development,
implementation, and regulation of managed care plans
licensed by the state; composition of board; directing the
board to review and comment on all matters of planning,
policy, development, program design and evaluation involving
managed care plans in the state; financing operations of
managed care policy board by a one half of one percent
assessment against premiums paid for coverage; requiring
board to recommend additions, deletions and revisions to the
standards used to license managed care plans; requiring the
board to recommend strategies and new initiatives for existing state-sponsored health information, ombudsmen and
external quality review programs; requiring the board to
conduct managed care policy studies; requiring the board to
meet at least four times every year and to elect officers,
etc.; and, requiring the board to prepare and send to the
governor and the Legislature an annual report.

Be it enacted by the Legislature of West Virginia:That chapter thirty-three of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, be amended by
adding thereto a new article, designated article twenty-five-d,
to read as follows:ARTICLE 25D. MANAGED CARE POLICY BOARD.§33-25D-1. Creation of managed care policy board to oversee
managed care providers; primary purposes; number of members; composition of members; meetings; election of officers and designation of committees.There is hereby created the managed care policy board whose
primary purposes are to oversee and monitor the development,
implementation and regulation of all managed care plans by any
health maintenance organization, health care corporation or other
health care plan provider sanctioned to provide health care
under the laws of this state.The board shall be composed of no fewer than fifteen and no
more than thirty members, all of whom shall be appointed by the
governor with the advice and consent of the Senate. A majority
of any sitting board shall consist of consumers of medical or
health care plans and they shall reflect the diversity of the
state's population relative to race, ethnic origin, gender, age,
economic status, disability and health condition.The board shall meet at least four times every year, the
first such meeting to be held at the call of the governor within
one month of the initial appointment, at which time it shall
elect officers, designate committees and hire an executive
director to further its purposes.§33-25D-2. Duties of board.(a) The board shall review and comment on all matters related
to planning, policy development, program design and evaluation
related to managed care at all health maintenance organizations
and all health care corporations in the state. The board shall
particularly review any proposed cost increases to enrollees
while, additionally, reviewing existing laws concerning managed
care in order to comment and make recommendations for
constructive change to members of the Legislature on an annual
basis. It shall, additionally, recommend additions, deletions and
revisions to existing laws regulating the licensing of health
maintenance organizations, health care corporations and other managed care health care providers. Such recommendations shall
include, but not be limited to, strategies and new initiatives
for state-sponsored health care informative services, and whether
the appointment of state-sanctioned ombudsmen and external
quality review programs should be employed to improve the overall
quality of care by managed care providers in the state. The
board shall be available to present its comment and
recommendations and answer all inquiries during each regular
session of the Legislature, upon request of either the speaker of
the House or the president of the Senate. (b) The board shall conduct managed care policy studies
designed to determine and measure the impact of: (1) Introducing
risk-adjusted payment methodologies; (2) encouraging quality
assurance strategies for vulnerable populations; (3)creating
small employer and individual purchasing cooperatives; and, (4)
expanding consumer choice of managed care plans.(c) The board shall annually prepare and submit to the
governor, the president of the Senate, and the speaker of the
House of Delegates an annual report addressing the overall
implementation and full accounting of the state's managed care
system, including recommendations or changes in the
administration, regulation and legal requirements related to
health care and health care coverage.§33-25D-3. Funding of managed care policy board's activities.There is hereby created in the state treasury a special
revenue account, which shall be an appropriated, interest-bearing
account, designated as the managed care policy board fund. All
proceeds from this fund shall be used exclusively for the
purposes of the administration, regulation, promotion and study
of the managed care policy board.An annual fee equal to one and one-half percent of all
premiums paid to any managed care provider shall be collected by
the board from each such provider. For purposes of this article,
"managed care provider" means any health maintenance organization
or any health care corporation duly licensed and doing business
in this state. The fee collected herein shall be collected by
the board pursuant to this section and shall be deposited within
fifteen days after receipt to the managed care policy board fund
and dedicated to the purposes of this article.

NOTE: The purpose of this bill is to establish a managed
care policy board to oversee and monitor the development,
implementation, and regulation of managed care plans licensed by
the state. In fulfilling this purpose the bill provides for the
following: (1) Composition of board; (2) directing the board to
review and comment on all matters of planning, policy,
development, program design and evaluation involving managed care
plans in the state; (3) financing operations of managed care
policy board by a one half of one percent assessment against
premiums paid for coverage; (4) requiring board to recommend
additions, deletions, and revisions to the standards used to
license managed care plans; (5) requiring the board to recommend
strategies and new initiatives for existing state-sponsored
health information, ombudsmen and external quality review programs; (6) requiring the board to conduct managed care policy
studies; (7) requiring the board to meet at least four times
every year and to elect officers, etc.; and, (8) requiring the
board to prepare and send to the governor and the Legislature an
annual report.

Article 25D is new; therefore, strike-throughs and
underscoring have been omitted.